A new documentary spurs the debate over how we treat the elderly
RAGE AGAINST THE DARK
THE EXERCISE-BALL-LOVING, Viagra-popping, nipped-and-tucked Me Generation is in for a jolt. The leading edge of this demographic wave, born between 1946 and 1965, is now 58 years old. Despite a Richard Simmonslike zeal for physical perfection, baby boomers are going to—horror of horrors— die. But what may be worse for them is that, before they do, crumbling bodies
or failing minds will betray a significant number, landing them in institutionalized long-term care. Many have already had to park a parent in a nursing home—meaning they’ve witnessed first-hand the warehousing of the infirm that possibly awaits them as well. But will today’s seniors-in-waiting use their considerable clout and train their failing eyesight on the future? Is the boomer bulge willing to stare death, its arch-nemesis, in the eye and ask, “Is warehousing the old the way we want to go?”
Despite its considerable impact on consumerism, politics, pop culture—just about everything, really—the boom doesn’t seem to handle death all that well. Not yet, anyway. Patricia Raymaker, who stepped down as the chairperson of Health Canada’s National Advisory Council on Aging (NACA) in August, wonders whether baby boomers will rally to the cause of seeing to their own humane demise. “They are so powerful,” says Raymaker, “yet they seem to accept the status quo, when there’s so much that could be done better.” Raymaker’s hope is that people soon realize old age is closer than they are willing to think, and that they lean on federal and provincial politicians for failing their greying constituencies. We need, says Raymaker, compassionate, accessible, universal and publicly supported alternatives to stockpiling the aged in institutions that are profoundly demoralizing. “Unless we’re prepared to demand that decision-makers change now,” says Raymaker, “we’re not going to have much better.” Suggestions include better home care, group homes, supportive housing with ready access to services, and separating patients with dementia from those who still have their
mental faculties. Whatever mix is decided on, it will have to be done soon. Seniors constitute the fastest-growing population in Canada. There were an estimated 3.9 million Canadians aged 65 or older in 2001, 67 per cent more than in 1981. As the boomers windsurf toward retirement, however, the seniors contingent is expected to swell to 6.7 million in 2021 and 9.2 million
‘UnleSS we’re prepared to demand that decision-makers change now, we’re not going to have much better’
in 2041—accounting for nearly one in four Canadians. Fortunately, most of the elderly are capable of living on their own, says Health Canada, estimating that only about seven per cent of the 65-plus club now live in long-term-care facilities. Still, that could translate into 469,000 institutionalized seniors by 2021, and 644,000 by 2041.
Few observers seem to question the very nature of the old-folks’ homes themselves, although that seems to be changing with John Kästner. The Emmy Award-winning filmmaker has come along with Rage Against the Darkness, which examines the institutionalization of seniors. With his documentary, Kastner hopes to get the ball rolling on a national debate on the treatment of the elderly. While his film shows facilities staffed by caring individuals, the institutions are fundamentally soul-crushing. “The people are wonderful, but, in some respects, these places are nonetheless hellholes,” says
A new documentary spurs the debate over how we treat the elderly
Kastner. “You’ve got to ask yourself if there isn’t some better way of doing this.” Kastner acknowledges the good work done in the homes. Long-term-care institutions, for example, provide regular meals, fulltime medical attention, companionship, and relief for overwhelmed families incapable of providing 24-hour care. But new residents often leave behind family homes and a lifetime of possessions, taking little more than a single suitcase to share a claustrophobic, hospital-like single room with a complete stranger. Nursing homes frequently combine mentally alert residents with demented patients prone to irrational and sometimes violent behaviour. And there is the unavoidable sense one is being put out to pasture. “It’s worse than going to prison,” is how Kastner recalls one resident describing the experience to him. “At least in prison you know you’re going to be free one day.” No one seriously suggests doing away with these homes. Rather, the focus is on keeping seniors out of them for as long as possible. In part, that can be accomplished by promoting healthy living—eating right, exercising, and avoiding injury. But the real answer—the big-ticket item so many advocates for the elderly are pushing for—is adequate home care. Because home care isn’t covered by the Canada Health Act, Ottawa has no jurisdiction and is forced to make conditional offers of money to the provinces. Also, the $2-billion National Home Care Program proposed by the Liberals is somewhat misleading in name. The funds largely target the home-care needs of patients discharged early from the hospital—not the chronically ill elderly who desperately need help. Judy Cutler, director of communications for CARP, Canada’s association for the 50-plus, says that needs to change. “It’s been clearly shown, in study after study,” says Cutler, “that where it is appropriate, home care is cheaper than institutional care, whether it’s a hospital or a nursing home.” At the moment, home care is a patchwork
of services that varíes from province to province, funded by a mix of public and private money. NACA’s interim report on seniors in Canada last year noted the hazards. “Selection of a retirement home,” the report says, “can be chancy, as a lack of a consistent process to ensure quality standards in services—either through regulation or accreditation-means there are some great homes and some awful ones.”
The Liberals have pledged to introduce a National Home Care Program, paid for by a new Home Care Fund that will total $2 billion over five years. But there’s a catch. The Liberals would dole out the money only to provinces and territories that pass legislation to govern “the provision of at least an agreedupon, minimum basket of home care services.” But the provinces, as Canadians are well aware, don’t appreciate health care
NURSING homes are ‘worse than going to prison. At least in prison you know you’re going to be free one day.’
dollars with strings attached. While pleased with the $ 2-billion pledge, says Cutler, the association and its 400,000 members remain “very concerned” that home care doesn’t seem to be on the provinces’ radar.
Progress is being made. The Health Council now reports on the quality of health care improvements, while the Institute of Aging, part of the Canadian Institutes of Health Research, is there to study our emerging needs. And beginning on Sept. 13, the premiers and territorial leaders meet with Prime Minister Paul Martin. The critical gathering, however, is shaping up to be another federal-provincial tug-of-war, this time over a proposed multi-billion-dollar national pharmacare program. “Politicians give us a little bit of lip service here and there, in Speeches from the Throne,” says Raymaker, “but I don’t believe they have paid attention to the impact of our aging population.”
That’s where the boomers come in. Health care has been the burning political issue in Canada for a decade because middle-aged, middle-class people made it so. And they’re probably going to have to focus their attention on life’s next stage before the old get the decent send-off we all deserve,
A TRAGICOMEDY WITH FEW LAUGHS
INANE TELEVISION dramas and outlandish pretenders to the reality-TV throne, step aside. True drama and reality are the purview of Rage Against the Darkness, a disturbing three-part documentary on the indignity of being elderly, infirm and forced to live in an old-age home. The CBC bills the series by Toronto-based, Emmy Award-winning director John Kastner as a “tragicomic” trilogy, but there is precious little here that’s funny. Viewers-aging baby boomers, in particular-might well be forgiven for feeling like Roger Daltrey, the Who’s frontman, who famously sang, “Hope I die before I get old.” Five troubling hours on what’s in store for some of us may be a bit much for sensitive viewers. But give it a chance, and you’ll be rewarded with a touching portrait of guiltridden families struggling with sending an unhappy senior off to die in someone else’s care. Set to air on the CBC on Sept. 15,16 and 19, and on CBC Newsworld beginning on Sept. 17, Rage Against the Darkness smartly raises tough questions while thankfully avoiding any high-moral-ground preaching. The series, filmed over three years, is not a condemnation of the individual seniors’ homes that granted Kastner broad access.
The facilities are staffed by caring health-care workers. It’s simply the nature of these placeseffectively, prisons for the agedthat Kastner implicitly criticizes.
In Toronto last year, “Bunny and Leona,” the first instalment, won for best Canadian feature at Hot Docs, North America’s largest festival of documentaries. Bunny, 67, and Leona, 72, are sisters who lived together for almost 30 years, but Bunny’s stroke, and Leona’s difficulty walking, force the two to live apart. Bunny’s initially positive attitude contrasts sharply with Leona’s. The elder sibling loathes the retirement home she is relegated to after a well-meaning but basically ill-conceived stint living with Bunny’s son. Leona eventually thrives in her newfound social milieu, but Bunny, unable to walk and barely capable of feeding herself, spirals downward into black despair. Kastner’s fine use of old photographs-there’s one of the two sisters as young girls in tidy gingham dresses-conveys how cruel time can be. We see Bunny confined in her wheelchair, three days after being admitted, demoralized by the many incoherent, mumbling residents. “I can’t live here,” she laments. “I can’t face this day after day after day.” “Gert’s Secret,” the second in the series, features its most engaging character. At 102, Gert is a sparkplug. She’s lived in a home for
16 years, and still gets out to bet on the horses. But we never really learn her secret for living happily in a home, other than a brief flick at the obvious-Gert’s relative good health is part of it.
That’s a shame. The charming old girl must have something to say about how she remains so cheerful in such a grim place.
The final instalment is the best. “Living Dangerously” follows Uncle Phil, 88, who suffers from osteoporosis but won’t leave his home, in spite of having collapsed into several diabetic comas. Meantime, Helen, an 82-year-old widow with failing eyesight, can barely get around the house. Their families try to cajole both into abandoning their homes, insisting what wonderful places longterm-care facilities can be. Helen’s son Ken sees mom isn’t buying it. “She knows where she’s going,” says Ken. “It’s not Disneyland.” Ultimately, Rage Against the Darkness leaves viewers to wonder why we haven’t found a better way. D.H.
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